Tobacco smoking addiction: a challenge to the National Health Service.

Abstract

SummaryPioneer researches concerning the connection between the smoking addiction and lung cancer provided the National Health Service with its first major test in the field of preventive medicine. It is instructive in examine how this problem was handled in the period 1950 to 1962. The NHS legislation of 1946 envisaged that the new service would take on an active preventive rote and that it would respond flexibly to new demands. At the heart of the new central administration was an elaborate professional advisory machinery designed precisely for the purpose of ensuring prompt response to new needs.The connection between smoking and lung cancer became a live issue in the immediate post‐war period through the researches of Kennaway sponsored by the British Empire Research Campaign. This work was carried to a striking conclusion in the epidemiological context by Doll and Hill in 1950. Subsequent investigations strongly supported their conclusions.Within the Ministry of Health smoking and lung cancer was the prerogative of the Cancer Standing Advisory Committee for which this problem was an uncongenial side issue. Positive action was precluded by strong objections within the Cancer SAC to ‘cancer education’. A vociferous minority within the advisory structure campaigned to generate a more positive attitude, but once formed there was great reluctance to modify, let alone reverse, medical policy decisions. Eventually the unresponsive Cancer SAC was by‐passed. The mart prestigious and broadly based Medical SAC and the Central Health Services Council gradually awoke to the importance of this issue. Crucial to keeping this issue alive was the increasing publicity in the press which resulted in persistent parliamentary questioning.Complete conversion was rendered more difficult by virtue of lack of sympathy of Ministers and officials within the Ministry of Health. MRC generally supported the work of Doll and Hill, but a strongly positive and independent line would have prejudiced relations with the Ministry of Health. A distinct change in the official attitude awaited the 1962 report of the Royal College of Physicians, after which further procrastination seemed inadmissible. But even then, after 12 years of inactivity, the National Health Service was not mobilized to make smoking and health a major issue on its agenda.